Many women deal with heavy periods — bleeding that is above normal or goes on for a prolonged amount of time. The definition of a normal or a heavy period differs for each woman, but the Centers for Disease Control and Prevention states that menstrual bleeding usually lasts about 4 to 5 days with a loss of 2 to 3 tablespoons of blood. Menorrhagia is the medical term for heavy menstrual bleeding, and the first criteria for it is menstrual bleeding that lasts for seven days or more.

According to the CDC, more than 10 million American women suffer each year from menorrhagia. That’s about 20% of the country’s adult female population. Good health and good quality of life depend on recognizing and treating excessive menstrual bleeding.

The symptoms

Women can recognize menorrhagia by looking for its symptoms during their menstrual cycles. When they are noticed, it is important to speak with a physician about potential treatments. Common menorrhagia symptoms include:

• Continuous pain in the lower stomach.
• Having to wear a tampon and a pad, or two pads, at the same time to control bleeding.
• Bleeding that requires changing a tampon or pad every hour for several hours.
• Having to wake up during the night to change a pad or tampon.
• Bleeding for more than a week.
• Blood clots the size of a quarter or larger.
• Fatigue, difficulty breathing, and other anemia symptoms.
• Being unable to take part in normal daily activities.

It is important to see your physician right away if:

• You need to change a tampon or pad every hour for more than two hours.
• Vaginal bleeding occurs after menopause.
• You have bleeding in between periods.

Causes of Heavy Periods

In half of the cases of menorrhagia, the exact cause cannot be determined, the CDC says. However, common causes include:

• Hormone imbalance. Estrogen and progesterone regulate the lining of the uterus during the menstrual cycle. An imbalance of these hormones can cause development of a thicker lining, and when that is shed during menstruation, the bleeding will be heavier than usual. Obesity, insulin resistance, thyroid issues, and polycystic ovary syndrome can all cause hormone imbalances.
• Intrauterine device (IUD). Menorrhagia is a common problem among women who use copper intrauterine devices instead of hormonal birth control.
• Uterine polyps are small, benign growths that develop on the uterine lining. They can lead to heavy or prolonged menstrual bleeding.
• Uterine fibroids. During childbearing years, these benign uterine tumors sometimes develop, causing heavy menstrual flow or prolonged bleeding.
• Ovary dysfunction. If an ovary, or egg, is not released during a cycle, it can cause a hormone imbalance and heavy period bleeding.
• Medications. Several medications can cause heavy or extended menstruation, including anti-inflammatory drugs and anticoagulants like warfarin or enoxaparin.
• Cancer and Precancer . Uterine and cervical cancer may cause heavy menstrual bleeding. Some hormone producing ovarian cancers can also cause heavy cycles.
• Adenomyosis. This occurs when the endometrial tissue that lines the uterus grows into the walls of the uterus, causing swelling, pain and heavy bleeding.
• Complications during pregnancy. Conditions such as a low-lying placenta or placenta previa can cause heavy bleeding during pregnancy. Also, a miscarriage can cause a late period with heavy bleeding.
• Inherited bleeding illnesses. Blood diseases like Von Willebrand’s disease, a blood-clotting illness, may produce irregular menstrual flow.
• Other illnesses. Liver and kidney disease, as well as other conditions, have been linked to menorrhagia.

Diagnosis of Heavy Periods

Most physicians start the diagnosis process with a pelvic exam and by collecting a patient’s medical history. Women can document their menstrual cycles before the exam to show the doctor how severe their bleeding is.

When checking for heavy periods, a doctor will usually ask the following questions:

• What is your typical menstrual cycle like?
• How do your periods affect your quality of life?
• When did your last period start?
• How have your periods changed over time?
• Do you bleed for consecutive days, or is there spotting in between?
• How many pads or tampons do you normally use during a period?
• Do you pass large clots?
• Are you sexually active?
• What type of birth control are you using?
• Do you have a family history of bleeding disorders?

Some questions that women may want to write down and ask their doctors are:

• Are my periods considered normal?
• Why am I having heavy periods?
• Is passing clots normal during periods?
• Is it normal for periods to interfere with some of my daily activities?
• Should I be exhausted during my periods?
• What are my treatment options?

Tests

In addition to performing a physical exam and asking for medical history, doctors sometimes perform other tests to make or confirm a menorrhagia diagnosis. These tests can include:

• Blood test. Blood may be drawn to test for anemia, thyroid problems, blood-clotting function and other problems.
• Pap test. Cells from the cervix are gathered and tested for signs of inflammation, infection, and cancer.
• Endometrial biopsy. A doctor removes tissue from the uterine lining to check for abnormal cells. This is typically done in women more than 45 years of age or younger if you have other risk factors for endometrial hyperplasia / cancer
• Doctors use soundwaves to look at your pelvic organs, blood vessels, and other soft tissues.

Based on the results, doctors might also recommend other tests, including:

• A doctor injects fluid into the uterus then does an ultrasound exam of your uterine lining. Women can expect mild to moderate cramping during the procedure caused by pressure from the tube.
• Doctors use a scope to look at the inside of the uterus for fibroids, polyps, and other causes of heavy bleeding. Anesthesia is needed.
• Dilation and curettage (D&C). In another procedure that requires anesthesia, a doctor scrapes and examines the uterine lining to determine the cause of bleeding.

Managing and Treating Heavy Periods

Both the cause and severity of heavy periods help determine the best treatment. Some treatments require one application and others are long-term. Doctors consider several factors when creating treatment plans, including:

• Age
• Medical history
• Current medications, such as birth control
• Reaction to certain medications
• Prior treatments and therapies
• Whether the woman experiences pain during menstrual cycles
• Whether the woman wants to have periods
• Whether the woman wants to have children

Drug treatments

Many drug treatment options exist for the treatment of heavy menstrual periods:

• Iron supplements. Available for those who show signs of low iron and iron deficiency anemia.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). Minimizes discomfort, menstrual cramps, and bleeding. NSAIDS may increase bleeding in some women.
• Birth control pills. Reduces bleeding and helps establish a more normal menstrual cycle.
• Hormonal IUD. Hormone-releasing uterine devices to regulate periods and minimize bleeding. Can cause heavy bleeding in some women.
• Hormone therapy. Treatment with estrogen and/or progesterone can reduce bleeding.
• Desmopressin nasal spray. Releases a clotting protein to minimize bleeding. Helpful in patients with von Willebrand’s disease
• Antifibrinolytic medicine. Medicines like tranexamic acid restrict blood loss

Surgical treatments

Patients can choose from surgical options to reduce or stop bleeding and ease other symptoms. Among the available options are:

• D&C. To reduce monthly bleeding, a doctor will dilate the cervix and scrape or vacuum tissue from the uterine lining. This procedure can stop aggressive bleeding, but it may need to be repeated multiple times.
• Focused ultrasound surgery. Uses sound waves to shrink fibroids in the uterus by destroying fibroid tissue.
• Hysterectomy. Completely removal of the uterus and cervix. It ends menstrual cycles and causes sterility. Requires anesthesia and hospitalization.
• Myomectomy. A surgeon removes fibroids, using either open abdominal surgery, laparoscopy via tiny incisions, or hysteroscopy via the vagina and cervix.
• Uterine artery embolization. A surgeon cuts off the blood supply to fibroids by blocking the arteries that feed them.
• Endometrial ablation. The use of a laser, radiofrequency, cerine or heat technology to destroy the uterine lining. This method reduces bleeding in most women, although it causes fertility and pregnancy difficulties. Doctors highly recommend the use of birth control after this procedure.

Improve Your Quality of Life

If you suffer from menorrhagia, a trip to Florida Medical Clinic Orlando Heath might change your life. For all of your obstetrical and gynecological needs, we offer a staff of experts that are both qualified and sympathetic.

The obstetrics and gynecology services offered by the Florida Medical Clinic include cervical biopsies, hysterectomies, endometrial ablation, hysteroscopies, hormone therapies, laparoscopies, and more. Contact us today to start treatment for heavy periods.

Meet Dr. Arpitha Polagani

Dr. Arpitha Polagani is a board-certified gynecologist serving the Wesley Chapel community. She specializes in infertility, pelvic organ prolapse, and a wide range of general gynecological conditions. Dedicated to providing compassionate, personalized care, Dr. Polagani is committed to supporting women through every stage of life. If you would like to schedule and appointment with Dr. Polagani, call 813-991-7416.